Trends in hospital admissions for childhood fractures in England

PurposeFractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals.DesignThe study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children.ResultsDuring 2012–2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5–9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10–15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0–4) children has been increasing at a rate of 0.629 per 100 000 children per year.ImplicationsThe annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes.

Changing To Removable Casts During The Coronavirus Pandemic – Has It Affected Outcomes For Distal Radius Fractures?

Background: BOAST (British Orthopaedic Association Standards for Trauma & Orthopaedics) guidelines recommended that during the coronavirus pandemic most upper limb fractures should be treated conservatively, and removable casts should be used, where possible. As a result, our district general hospital started using a new soft combination (soft-combi) casting technique for conservative management of distal radius fractures (DRFs) in an attempt to reduce follow-up attendances.Aims: To assess if radiological outcomes of soft-combi casts are better or worse than previously used rigid casts for DRFs.Methods: 20 DRFs treated with soft-combi casts were compared with 20 DRFs treated with the old rigid cast types. Radiological parameters were measured pre-manipulation, post-manipulation, at 2-week follow-up, and at final follow-up. Statistical analysis was performed to assess for significant differences seen at follow-up between the groups.Results: The mean loss of volar angulation seen at 2-week follow-up was 4.9 degrees for the rigid casts vs. 1.5 degrees for the soft-combi casts (p=0.158). The mean loss of radial height after 2 weeks was 0.2 mm vs 0.5 mm (p=0.675), and the mean loss of radial inclination was 2.0 degrees vs 1.0 degrees (p=0.349), respectively.Conclusion: The soft-combi casts appeared to be equally effective at maintaining the reduction of DRFs compared to their rigid counterparts, as no statistically significant difference was seen in our study. We can be reassured that continued use of these removable casts in the current climate is unlikely to have a detrimental effect on outcomes for DRFs.

Bone versus implant: an atypical presentation of a typical complication of forearm fractures

<p class="abstract">Both bone forearm fractures are one of the most common upper limb fractures operated by orthopedicians. Although the primary surgery is usually relatively straight forward and simple, but we present a case where the primary surgery failed and the patient presented with a deformed hand after 5 months, even though there were signs of union on radiographs. When operated upon, although the ulna had undergone primary bone healing and a peri-implant fracture had occurred, whereas radius had refractured from the fracture site and the plate was bent giving the deformed appearance. We discuss this unique complication, the planning, difficulties and scope of errors in such a situation, where the race to union is won by ulna but lost by radius.</p>